National report — What do Afrin (oxymetazoline, Schering-Plough) and brimonidine have in common with rosacea? Believe it or not, both medications — a nasal decongestant and glaucoma eye drops — are the basis for some exciting new treatment possibilities for the chronic skin disorder.

Brimonidine, the glaucoma drop ingredient, is an alpha2-adrenergic receptor agonist, while oxymetazoline — the active ingredient in Afrin — is classified as an alpha1-adrenergic receptor agonist.

James J. Leyden, M.D., professor emeritus, University of Pennsylvania, Philadelphia, has a long history with the university's rosacea clinic and has been involved in the studies of brimonidine for several years.

Dr. Leyden describes the redness as significantly reduced when the brimonidine is applied, and he says that patients are thrilled with the results.

"They're ecstatic. They know the result isn't permanent and will wear off in a matter of hours, but just the fact that redness can be controlled is more than what they have had," Dr. Leyden tells Dermatology Times.

While there is no medical reason for the preparation to have a lasting effect on a patient's basic rosacea erythema, Dr. Leyden says some improvement can often be seen in that baseline redness.

"It may be because stress is one of the contributing factors in rosacea. Once the patient knows there is a way to reduce the redness, they worry less about a flare-up, and the base redness decreases as a result," he says.

ETR subtype

The erythematotelangiectatic (ETR) subtype of rosacea does not always respond well to traditional treatments of topical or oral antibiotics, but it may be showing a response to anti-inflammatories.

In a paper published from a very small study at the University of New Mexico, Mexico City, Stuart D. Shanler, M.D., and Andrew Ondo, M.D., reported on the once-a-day topical application of oxymetazoline hydrochloride, 0.05 percent, solution to skin affected by rosacea. Oxymetazoline is currently found in topical decongestant nasal sprays as oxymetazoline hydrochloride in products such as Afrin, Vicks Sinex (Procter & Gamble) and Zicam (Matrixx Initiatives).

The paper noted a marked decrease in redness within an hour after the application, which lasted four to six hours.

In addition to acting as a vasoconstrictor, the researchers reported that the oxymetazoline also demonstrated anti-inflammatory properties.

Dr. Shanler holds the patent on the medication and is a partner in a private pharmaceutical firm looking to develop topical dermatological treatments.

Leslie Baumann, M.D., director of the University of Miami Cosmetic Medicine and Research Institute, Miami, and professor of clinical dermatology and chief of the division of cosmetic dermatology at the University of Miami, Miami, has seen the results of oxymetazoline on patients' rosacea.

"This treatment offers some very exciting possibilities, and patients are very thrilled with the results," she says.

Dr. Baumann says that doesn't mean Afrin is the answer to rosacea flare-ups.

"I would caution patients with rosacea not to go out and apply straight Afrin on their skin. Afrin contains several ingredients that can be irritating. But the ingredients used in Afrin do show signs of offering a breakthrough in rosacea treatment in the future," she says.

Disclosures: Dr. Leyden is a consultant for many pharmaceutical companies. Dr. Baumann is on the advisory board for Stiefel, Procter & Gamble, Philosophy, Vichy, Borba and Medicis. She is an investigator for Galderma, Medicis, Allergan, Johnson & Johnson, Avon, Unilever and DermWorx, and is a speaker for La Roche-Posay.